tbuckley/cabot-search huggingface dataset:
Anticancer–drug-induced interstitial lung disease (DIILD): With great power comes great responsibility.
Authors: Arun Maseeh, Bhawana Awasthy, Somrita Modak
Journal: Journal of Clinical Oncology (2023)

e18699 Background: DIILD accounts for 3-5% of all ILD cases, with Anticancer agents accounting for 23-51% of all cases, and Case-Fatality Rates of 51.3%. Guidelines for anticancer therapy-related DIILD are lacking. DIILD was not often identified as an adverse event until late in drug development or after launch. Methods: Publications till Feb 2023 were reviewed for incidence, time to onset, prevention and early identification of anticancer DIILD. Results: Highest reportedincidence of DIILD was associated with targeted therapies [mTOR Inhibitors (9.5- 58%), Anti-EGFR (0.9 - 5.9%), MEK inhibitors (2.4%), CDK 4/6 inhibitors (1.6%), PARP inhibitors (0.79%)]; Chemotherapy [Bleomycin (6.8-21%), Gemcitabine(1.1-3.9%), Irinotecan (0.74%)]; ADCs (11.4%); CTLA4 inhibitors (5.44%); and Check-point inhibitors [(CPIs: 1.1-3.6%), PD-1 inhibitors (3.6%), PD-L1 inhibitors (1.3%)]. The rates of DIILD were higher in combinations compared to single-agents. Higher Mortality rates were associated with Anti-EGFR (18-51.3%), Irinotecan (24%), Bleomycin (8.1-23%), Gemcitabine (0-22%), mTOR Inhibitors (0-20%), Check-point inhibitors (all CPIs: 8-9.4%). The time of onset was as early as a week for CPIs (42% occurred within first two months), 28 days for EGFR:TKIs, 60-172 days for MEK Inhibitors, and 14-638 days for ADCs. Risk-mitigation strategies for DIILD: Identification of high-risk patients – (multiple prior lines of therapy, combination therapy, lung comorbidities, poor respiratory reserve, smokers). Early radiological diagnosis accompanied by Monitoringfor early signs of ILD with wearable technology. Conclusions: Research in Genomics and biomarkers to identify patients at risk, development of Artificial Intelligence (AI) algorithms for PFT interpretation, early radiological detection and audiometry analysis are ongoing and urgently needed.
Investigating the impact of demographic disparities on clinical outcomes in cutaneous T-cell lymphoma (CTCL): A multicenter retrospective cohort analysis.
Authors: Tim Niyogusaba, Jeffrey M. Switchenko, Sima Rozati, Swaminathan Padmanabhan Iyer, Sai Talluru, Auris Huen, Irl Brian Greenwell, Jane Scribner, Sunil Rangarajan, Amitkumar Mehta, Anne Beaven, Safiyah Bhatti, Shalini Krishanasamy, Pierluigi Porcu, Tarsheen Sethi, Francine M. Foss, Darina Paulino, Katherine Case, Mary Jo Lechowicz, Pamela Blair Allen
Journal: Journal of Clinical Oncology (2023)

7573 Background: Black patients have been shown to have a higher incidence of cutaneous T-cell lymphomas (CTCL) and display unique clinicopathologic features at diagnosis, however, drivers of these disparities and the role of social determinants of health (SDoH) remain poorly understood. Methods: To further characterize the prognostic relevance of racial and demographic disparities in CTCL, we performed a retrospective review of 1,198 patients seen at 8 different academic treatment centers in the United States between 2000-2020. Clinical variables included demographics, disease characteristics, and survival. Race and ethnicity were stratified into 2 groups for this analysis: non-Hispanic Black (B) and Non-Black (NB). Distance to center was stratified into short, intermediate, or long commute ( &lt; 10, 10-50, &gt; 50 miles, respectively) based on home zip code. The primary endpoint was overall survival (OS). Univariate association and multivariable analyses were assessed using Cox proportional hazards models. Results: Among 1,198 total patients, 42.4% identified as B and 58.6% as NB. B patients presented younger, had a shorter commute, lower income, but no difference in insurance compared to NB patients. There was no difference in survival by race (Median OS 74 months (95% CI 65-84) compared to 65 (95% CI 58-75) for NB patients). Distance to center was strongly associated with survival and remained significant on multivariate analyses after controlling for age, race, and other SDoH. Longer commute was associated with worse OS compared to short commute for both B and NB counterparts (median 55 months [95% CI 49-66] vs. 79 [95% CI 69-90] and 75 [95% CI 63-86], respectively, p = 0.006). Conclusions: We characterized the impact of race and SDoH on overall survival (OS) in a diverse, multicenter cohort of patients with CTCL. We found that distance to cancer center was the most important factor contributing to disparities in OS in this study. This highlights the importance of improving access to care, particularly in rare and clinically heterogeneous diseases such as CTCL.
The role of molecular biomarker CDKN-2A in early diagnosis of colorectal cancer.
Authors: Yakov Ten, Mirzagaleb Nigmatovich, Yakhyo Ziyaev, Hurshid Islamov, Nargiza Nematovna Zakhirova
Journal: Journal of Clinical Oncology (2023)

10581 Background: Polyps are considered as obligate precancerous disease. The percentage of malignization ranges from 20% in single polyps to 95% in diffuse polyposis. Current research examines the results of the early diagnosis of colon cancer by using the biomarker CDKN2A for development of molecular-biological methods of prognostication. The correlation with the molecular-biological indicators were studied. It is also planned to develop an effective system for development prognostication of CRC and the formation of "risk groups" for evidence-based counselling for families which are highly predisposed to colorectal cancer. Methods: Investigations were carried out in 30 patients during the period 2016-2022, the study included patients with single polyps, multiple polyps, polyposis of the colon, as well as patients without a history of either familial or sporadic cancer. 12 patients had multiple polyps, 9 polyposis and 9 single colon polyps. The levels of methylation of the gene CDKN2A were determined in 10 patients. The material for the isolation of DNA was a serum obtained from venous blood, and biopsy material. DNA extraction was held according to standards. After the conversion of DNA methyl-specific PCR was done. Results: Among 30 patients with polyps and polyposis of the colon, serum gene CDKN2A methylated DNA was detected in 10 patients. In 4 patients malignization of the polyp was determined. If patients without malignization surgical intervention was limited with resection of the intestine without lymph dissection. In 20 patients the test result was negative. We did not perform surgical intervention to these patients and they were sent to dynamic observation. Thus, the diagnostic efficacy of detecting colorectal cancer in early diagnosis of by means of methylated DNA of the gene CDKN2A was - 33.3%. Conclusions: If there is a positive test for methylation of the CDKN2A-gene, the risk of colorectal cancer is considered very high and these patients underwent surgical treatment. Application of the molecular biological marker CDKN2A may be an effective method in early diagnosis of malignization of polyps.
Association of inability to secure timely medical appointment and medication non-adherence among cancer survivors in the US.
Authors: Onyema Chido-Amajuoyi, Ikponmwosa Osaghae, Tochukwu Nzeako, Joya Chandra, Sanjay Shete
Journal: Journal of Clinical Oncology (2023)

e18595 Background: Access to health care is defined as the “timely use of personal health services to achieve the best possible health outcomes.” Cancer survivors have higher health care utilization than individuals without a history of cancer, yet studies examining health care access and its impact on medication adherence in this population are lacking. Methods: Study data were derived from the National Health Interview Survey. The prevalence of reports of inability to secure timely medical appointment among cancer survivors was estimated by respondent characteristics. Weighted multivariable logistic regressions were used to assess the relationship between inability to secure timely medical appointment and medication non-adherence among Cancer Survivors in the US. Results: Respondents were a total of 2,590 cancer survivors, of which 8.9% (n = 225) reported inability to secure timely medical appointment. The prevalence of reports of inability to secure timely medical appointment were higher among those without insurance coverage (17.3%), earning income &lt; $34,999 (12.3%), those aged 18-45 years (15.9%), American Indian natives (32.2%), and females (10.4%). The odds of skipping medication to save money was almost four-fold higher for cancer survivors who were unable to secure timely medical appointment (adjusted odds ratio (aOR) 3.84; 95% CI: 2.19-6.74), compared to those who did not experience delays securing medical appointment. Similarly, the odds of taking less medication to save money was almost five-fold higher for cancer survivors who were unable to secure timely medical appointment (aOR 4.99; 95% CI: 2.83-8.77), compared to those who did not experience delays securing medical appointment. The association remained significant even after adjusting for potential confounding factors. Conclusions: This study found a significant association between inability to secure timely medical appointment and medication non-adherence among cancer survivors in the United States. These findings highlight the importance of timely medical care for cancer survivors and the potential consequences of delay in getting medical appointments, such as medication non-adherence. Interventions aimed at reducing delay in accessing medical care and improving medication adherence may improve outcomes among cancer survivors.
Cancer deaths in the state of Sao Paulo, Brazil: Is there a solution for disparities among private and public services?
Authors: Daniel D Almeida Preto, André Luiz Pinto Santos, Joao Neif, Flavio Mavignier Carcano, Sergio Vicente Serrano, Gilberto Lopes, Nelson Teich
Journal: Journal of Clinical Oncology (2023)

e18677 Background: There is a notable discrepancy between resources available for the private and public health care services that care for Brazilian people living with cancer. Barretos Cancer Hospital (Barretos) is a Sao Paulo countryside public hospital that stands out in Brazil for its approach of supplementing government receipts with philanthropy and fundraising, allowing it to incorporate state-of-the-art technology in the prevention, screening, and treatment of cancer. However, the availability of systemic therapies in Barretos is still restricted to the list contemplated in the public health system procedures. Lack of access to innovative systemic therapies may hinder survival. As such we aimed to evaluate the outcomes of patients treated in Barretos compared to other public and private institutions in Sao Paulo, Brazil. Methods: We performed a retrospective analysis of the public database of the Fundação Oncocentro de São Paulo, including new patients diagnosed with cancer in the period from 2013 to 2017, assessing tumor type, clinical staging, cancer survival, and treatment site (private/public/Barretos). We used Cox proportional-hazards regression for survival data with R Statistical Software, taking Barretos as reference compared to private and public services (excluding Barretos). Results: We analyzed data from 133,868 patients with the most prevalent cancers in the state: breast (n = 45,402), prostate (n = 36,046), colorectal (n = 23,951), cervical (n = 13,801) and lung (n = 14,668). More than two thirds of patients (69.88%) received treatment in public services, 16.71% in private centers and 13.41% in Barretos. There were no significant differences in OS between private centers and Barretos for patients with cancer stages 0 and I (HR 1.1; p = .48; CI 95%). For patients with stage II breast, cervical and lung cancers, and for patients with stage III cervical and prostate tumors, there were no significant differences in OS between Barretos and private services. For all patients in stages 0-I, II and III, Barretos had better survival than other public centers (HR 2.8; 1.3; 1.3, respectively p &lt; .001; CI 95%). In stage IV cancers, Barretos had worse survival than private institutions (HR 0.6; p &lt; .001; CI 95%) and only patients with stage IV prostate and cervical cancers had better outcomes in Barretos than in other public services. Conclusions: Strategies for earlier incorporation of health technologies have the potential to decrease disparities between public and private services in Brazil. The lack of access to novel systemic therapies likely led to poorer outcomes for patients with metastatic disease in Barretos and other public services. These data indicate that greater government investment in early diagnosis and treatment programs are needed to improve outcomes in resource-limited settings.
Exploring the unmet needs of Mexican women living with metastatic breast cancer: A patient survey.
Authors: Luis Fernando Enriquez, Sebastian Reyes-Lizaola, Daniela Vazquez Juarez, Alejandra Platas, Ana Laura Platas, Cynthia Villarreal-Garza
Journal: Journal of Clinical Oncology (2023)

e24223 Background: Breast cancer is the most prevalent form of cancer among women worldwide and the top cause of cancer-related fatalities. In Mexico, delayed diagnosis and referral contribute to a significant proportion of breast cancer patients being diagnosed with metastatic breast cancer (mBC) or experiencing distant recurrences. Patients with mBC face unique needs and concerns for their illness, which are frequently not attended to or covered. Gaining insight into their diagnostic experiences is crucial for enhancing the standard of care. The aim of this study is to explore the unmet needs of Mexican women living with mBC. Methods: An anonymous and voluntary survey was distributed to women diagnosed with mBC. The instrument employed was drawn from the European "Being There" study and underwent translation into Spanish in accordance with the current best practices for the translation and cultural adaptation of health measurement tools. The survey addressed various subjects including patient’s personal experiences concerning diagnosis and treatment, attitudes of healthcare providers toward cancer services, information available to patients, and patients' views on enhancing future care. Results: A total of 29 responses were received from women ranging in age from 26 - 74 years. Despite generally positive feedback on the care received (42% as excellent/very good, 55% as good/acceptable, and only 3% as bad), these women identified areas for improvement. Regarding their personal experience receiving information about their diagnosis and treatment, 86% reported receiving medical attention that helped them cope with their illness and 80% reported being convinced that the medical team was highly qualified and coordinated. However, only 55% of physicians and 44% of nursing staff displayed interest in the patients' goals and wishes after they received their diagnosis. Regarding the attitudes of healthcare providers in cancer services, 62% of the women believed that they should be more empathetic, 65% would like to see the same doctor/nurse/specialist on every visit, and 69% indicated that they would like them to show more interest in the challenges they face on a day-to-day basis. Table 1 summarizes the information that these women would like to receive about their treatment. Conclusions: In conclusion, this study provides insight into the experiences and unmet needs of women living with mBC in Mexico. While the care received by the women was generally positive, the study highlights the need for improvement in certain areas to address their unmet needs. The findings can be used to enhance the standard of care for women with mBC. [Table: see text]
Molecular profiling in a Peruvian population with advanced non-small cell lung cancer assessed by NGS.
Authors: Marco Galvez-Nino, Carolina Belmar-Lopez, Rossana Ruiz, Pamela Carrion, Diana Diaz, Manuel Chumpitaz, Jose Maria Gutierrez, María Requena, Joseph Pinto, Luis Mas
Journal: Journal of Clinical Oncology (2023)

e20612 Background: The use of next generation sequencing (NGS) both at diagnosis and disease progression has allowed us to detect changes in the genetic profile of patients that are potentially targetable. In this study we will describe the genetic profile of patients both at diagnosis and disease progression using NGS in tissue sample (TS) and liquid biopsy (LB). Methods: We evaluated 403 patients diagnosed with non-small cell lung cancer (NSCLC) referred to ONCOGENOMICS laboratory from 2016 to 2022 to somatic mutation testing. NGS was performed using the Ampliseq for Illumina FOCUS panel and run on the Illumina MiSeq. The panel targets single nucleotide variants (SNVs) and insertion/deletions (indels), copy number variation (CNVs), and gene fusions in 52 genes associate to solid tumors. Raw data were processed automatically on the BaseSpace Sequence Hub (Illumina) and aligned to the hg19 reference genome The default limit of detection (LOD) was set at 5% allelic frequency (VAF) in tissue samples and 0.5% VAF in ccfDNA samples. The Human Genome Variation Society (HGVS) nomenclature guidelines (http://varnomen.hgvs.org/) were used to annotate identified variants and the ClinVar database (www.ncbi.nlm.nih.gov/clinvar/) was used to determine the biological significance of all reported variants. Results: Of the 403 patients, 351 patients had NGS at diagnosis and 52 patients in disease progression. Regarding the genetic profile at diagnosis, we analyzed 328 tissue samples and 23 liquid biopsies, the most frequent alteration was the EGFR mutation, detected in 116 (33.1%) patients (detection rate TS 32.6% and LB 39.1%), followed by KRAS (15.4%), ALK (2.6%), BRAF (1.9%), and others (4.8%). In the disease progression setting, we analyzed 34 tissue samples and 18 liquid biopsies, the most frequent alteration was the EGFR mutation, detected in 28 (53.8%) patients (TS detection rate 29.4% and LB 44.4%), followed by KRAS (15.4%), ALK (3.9%), and others (3.9%). Conclusions: Peruvian patients are a population with a high mutation rate, in this cohort almost 50% of them had a target mutation, especially the EGFR mutation. Likewise, it was found that the detection rate of the EGFR mutation was higher with NGS in liquid biopsy than in tissue samples, both in the diagnostic and in the disease progression samples. On the other hand, it is important to mention that the frequency of KRAS mutations found is higher than previous Peruvian reports.
Sedentary lifestyle as a predictor of early death in older adults with cancer: A prospective cohort study with 2692 patients.
Authors: Jurema Telles O Lima, Maria Julia Gonçalves Mello, Letícia telles Sales, Luis Filipe Miranda DOS Santos, Fernanda R de Melo Silva, Rafael M M C Rayol, José Roberto sILVA, José Iran Costa, Mirella Rebello, Zilda Cavalcanti, Luiz Claudio Santos Thuler
Journal: Journal of Clinical Oncology (2023)

12058 Background: Physical activity is an important aspect of the global health of older adults with cancer (OAC). The aim of this study was to determine sedentary lifestyle as a predictor of early death in OAC. Methods: Prospective cohort involving elderly (60+) with cancer, cared for in a public hospital in Pernambuco, from January 2015 to December 2021. Sociodemographic, clinical, and lifestyle variables were considered. The level of physical activity was assessed before cancer treatment by the International Physical Activity Questionnaire (IPAQ), short version, with classification into active (active/very active) and inactive (sedentary/inadequately active) and comprehensive geriatric assessment (CGA). The outcome was death within 180 days. Kaplan-Meier survival curves and Cox multivariate analysis were performed. Results: 2692 patients were included, most were men, with family income less than 01 minimum wage in almost 30%. The presence of two or more comorbidities was observed in 70.1% of patients. The main primary sites were prostate (30.8%), breast (17%) and digestive system (25.8%), gynecological system (10.6%), lung (5.9%), and the majority (67.6%) had no metastatic disease. There were 461 deaths (25.7% sedentary and 9.7% non-sedentary). Sedentary lifestyle was an independent risk factor for early death (HR=1.28,95% CI=1.07-1.64 p&lt; 0.036), controlled by tumor topography and presence or absence of metastasis, presence of polypharmacy and Karnofsky performance scale, recent hospitalization and nutritional status. At 180 days, survival among patients with some level of physical activity was higher (90% (0.88 - 0.92)) than among sedentary patients (74% (0.72 - 0.77, p &lt; 0.01). Conclusions: Sedentary lifestyle at the time of cancer diagnosis was an independent risk factor for early death among Older adults with cancer. Encouraging physical activity is an important public health action to face aging-related health problems, such as cancer.
Participation in a multidisciplinary institutional committee, “RQUEST,” to enhance quality improvement education, project design, and implementation for hematology/oncology fellows.
Authors: Tyler Fugere, Jim Zhongning Chen, Alan Baltz, Troy Schmit, Rana Douli, Md Shadiqul Hoque, Muhammad Khalil, Sajjad Akbar Bhatti
Journal: Journal of Clinical Oncology (2023)

e18733 Background: Participation in quality improvement (QI) projects allows medical trainees to develop an essential skillset to systematically analyze practice and implement changes with the goal of practice improvement. The ACGME designates QI education and participation as a core competency for all fellows. Training programs and institutions can vary significantly in QI educational format, participation, and direct support for project design and implementation. Here we present a description of the Resident Quality, Experience, and Safety Team (RQUEST) committee, which is being utilized by Hematology and Oncology fellows for QI project design and implementation at our institution. Methods: The first RQUEST committee was convened in August of 2021. RQUEST holds formal monthly meetings from August to June of each academic year. At the initial meetings, committee members are introduced to quality, safety, and patient experience structures and receive introductory training in QI tools and techniques. RQUEST members are then split into smaller project groups and work to select a QI project, perform current state analysis and baseline data collection, design and implement improvement interventions, and re-measure to determine the impact of the chosen interventions. The year concludes with each team presenting their project at a joint session to a larger audience of program directors, quality officers, service line directors, department chairs, graduate medical education staff, and hospital leadership RQUEST participation provides fellows with direct access to a multidisciplinary team and resources throughout project design and implementation. The timeline of monthly meetings provides both accountability and productive feedback. This facilitates the identification of system-specific opportunities for improvement and the most practical points of contact within the hospital, clinic, or EMR to design and apply quality interventions promptly and effectively. Results: We sent a voluntary survey to RQUEST participants, and 40% of participants responded to the survey. 100% of those who responded said participating in RQUEST has been beneficial in developing and implementing a QI project, and 100% said they would recommend participating in RQUEST to other medical trainees. The most common benefits listed were: · Structured approach/guidance · Institutional support and resources · A collaborative environment with a team of members from various departments, including IT. Conclusions: Fellow participation in a multidisciplinary QI committee at our institution has improved fellow QI education, participation, and project implementation. This engagement model has proven valuable to fellows and faculty in enhancing QI competency and clinical practice.